MAIL-IN HOROSCOPE DATA/ORDER FORM [Print this Page]
Natal Horoscope Reading $120 -- Both Natal and
12-Month Trends $215 -- 12-Month Trends Without Natal Reading $120 -- 12-Month Trends Re-Order $95
Ordering (Check One): Natal [__] Trends [__] Both Natal and Trends [__]
Name:____________________________________________________________
Birth: Month:____________________Date:________Year:__________
Time:______________ (Check One): AM [__] PM [__]
Birth City:___________________________________________________
State:_________________________________________________
Country:_____________________________________________________
Gender (Check One): Female [__] Male [__]
Present Address:
Street or Post Office Box:_________________________________________
City:________________________________________________________
State:_________________________________________________
Zip Code:_____________________
Home/Biz Phone (Optional at this time):_________________________
An Email Address (Required):______________________________
"OPTIONAL" COMMENTS~INFORMATION~QUESTIONS
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[Note: Personal/Business checks require 7 business days to clear]
Mail to: Elbert Wade, 3847 FM 2423, Grapeland, Texas 75844
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